Accidental Death Claim Denied Due To Drug Exclusion

Accidental death and dismemberment policies and riders offer coverage for deaths caused by accidents. Accidents are usually defined as unforeseeable, unintended events.

People buying accidental death coverage often think that this type of insurance covers any accident as long as the person did not die of natural causes. But this is not the case.

Almost all ADD policies have several exclusions in them. Exclusions are provisions in a contract that work to exclude certain deaths from coverage and, if applied, will result in an ADD claim denial.

Insurance companies design their accidental death policies in a way that almost any death can be excluded from coverage. An unsuspecting insurance buyer may believe that an accidental death and dismemberment policy is a guaranteed protection in case of accidental death and they are surprised to know that there are exclusions that can be interpreted in several ways and very broadly.

One of such exclusions is a drug exclusion. A drug exclusion usually says that the policy does not cover any loss resulting from an injury sustained while voluntarily taking drugs which federal law prohibits dispensing without a prescription unless the drug is taken as prescribed or administered by a licensed physician.

When a beneficiary files an ADD claim, the insurance company will request a toxicology report. The toxicology report usually shows the substances that were found in the insured’s body at the time of death.

Let’s suppose the insured was taking Oxycodone and it was reflected in the toxicology report. The insurance company will analyze the toxicology report to see whether the level of Oxycodone in the insured’s system was within a therapeutic range.

The insurance company will hire a medical expert to analyze the report. In some cases, the insurance company will send the report to an RN who will review it and render an opinion as to whether Oxycodone was taken according to a physician’s advice.

The problem with this is that medical experts rarely agree on what constitutes a therapeutic range for a drug without considering other factors. For example:

How old was the insured?

How long after death was the postmortem exam done?

Did the insured have liver failure? What are the liver function test results? What other medications was the insured taking?

Did he have any other illness at the time of death that could have slowed his metabolism?

Was the medication administered to the insured while he was unconscious?

When insurance companies’ consultants evaluate toxicology reports, they do not take into consideration all these factors and wrongfully deny many ADD claim.

In many cases, they simply put the drug concentration number in Dr. Winek’s Scale[1] or another drug concentration table to see in which range it falls and will deny a claim if the drug concentration is not within a therapeutic range.

Accidental death claim denials based on a drug exclusion can be complex and very confusing. They require medical experts and experienced life insurance attorneys.

A life insurance attorney who has handled many ADD claim denials in the past will know exactly what to do to get your ADD claim paid. Our law firm has successfully handled many denied accidental death claims. We have worked with reputable medical experts who provide reliable service. Our life insurance attorneys know how to deal with ADD claim denials to get claims paid fast.

Case Evaluation/Contact Us

Categories

The information on this website is for general information purposes only. Nothing on this site should be taken as legal advice for any individual case or situation. This information is not intended to create, and receipt or viewing does not constitute, an attorney-client relationship.